Experts say harm reduction is best goal for emerging drug policies

Washington, D.C., 26 June 2012 (PAHO/WHO) — In the Americas, the toll of illegal drugs has grown dramatically in recent years, but with different impacts on producing, consuming, and transit countries. To mitigate these different impacts, drug policy must address not just supply of drugs but demand reduction and the reduction of harms, said experts today at a panel discussion organized by the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Inter-American Drug Abuse Control Commission (CICAD) of the Organization of American States (OAS) to mark the International Day against Drug Abuse and Illicit Trafficking.

?Although substance use disorders are more prevalent in the developed countries of the Americas, the health burden of such disorders, especially in terms of disability-adjusted life years, is disproportionately high in low- and middle-income countries,? said PAHO Deputy Director Dr. Jon K. Andrus. ?Other negative consequences of drug traffic and use include crime, violence, corruption, and the violation of human rights.?

?Demand reduction is a priority to guarantee a comprehensive and balanced approach to the global drug problem, since we know that abuse is a social and health problem that requires a multisectoral and interdisciplinary approach,? said Álvaro Briones, Director of Policies and Programs at the OAS Secretariat for Multidimensional Security.

According to estimates of the United Nations Office on Drugs and Crime (UNODC), more than 40 million people in the Americas (6.9% of the population ages 15-64 years) had used cannabis as of 2006. Some 10 million had used cocaine, 5.7 million had used amphetamine-type stimulants, and 2.2 million had used heroin. In recent years, the trend in the Americas has been increasing use of amphetamine-type drugs, due to the availability of chemical precursors needed to synthesize methamphetamines. In South America, cannabis and cocaine use are also on the rise.

The potential health consequences of such drug use range from infection with HIV/AIDS and hepatitis B and C (from drug injection), to drug dependence, overdoses, suicides, and injuries. In addition, even occasional drug use may increase the risk of accidents, injuries, and interpersonal problems.

Evidence from countries that have taken different approaches to these problems suggests that neither stepped-up enforcement nor decriminalization of drugs has a significant impact on levels of drug use in the population, said Dr. Peter Reuter, Director of the University of Maryland's Program on the Economics of Crime and Justice Policy and a senior economist at the RAND Corporation. However, government policies can reduce the harms associated with both use and trafficking.

?Legalization would massively lower harms per user,? said Dr. Reuter, because ?most harms are the consequence of policy, not the drugs themselves.? He added that legalization would likely benefit poor and minority urban communities, because of the negative impacts of the drug trade in those groups. In contrast, middle-class communities could see a significant increase in use, with the resulting adverse effects. An exception to this scenario, he said, would be legalization of marijuana.

To support drug policymaking, PAHO and the OAS recently signed an agreement to work together in reviewing and analyzing the drug situation in the Americas and to develop a regional strategy and plan of action to address the problem. The joint efforts will focus on strengthening of institutional capacity, research and information systems, and demand reduction, with emphasis on early detection in primary healthcare services.

As the international debate on drug policy expands to consider new options, including decriminalization, it is important to take account of evidence while shaping policy, said the experts.

?Whatever we do in the future, and particularly the policies that we promote, must be based on evidence. If not, we condemn ourselves to relying on uncertainty and intuition at a time when we are making our most important decisions,? said Briones.

PAHO, which celebrates its 110th anniversary this year, is the oldest public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.